Finding brilliance using positive organizational scholarship in healthcare

'When a patient chooses to die at home, that's what they want… comfort, home': Brilliance in community-based palliative care nursing

INTRODUCTION

To redress the scholarly preoccupation with gaps, issues, and problems in palliative care, this article extends previous findings on what constitutes brilliant palliative care to ask what brilliant nursing practices are supported and promoted.

METHODS

This study involved the methodology of POSH-VRE, which combines positive organisational scholarship in healthcare (POSH) with video-reflexive ethnography (VRE). From August 2015 to May 2017, inclusive, nurses affiliated with a community health service who delivered palliative care, contributed to this study as co-researchers (n = 4) or participants (n = 20). Patients who received palliative care (n = 30) and carers (n = 16) contributed as secondary participants, as they were part of observed instances of palliative care. With a particular focus on the practices and experiences that exceeded expectations and brought joy and delight, the study involved capturing video-recordings of community-based palliative care in situ; reflexively analysing the recordings with the nurses; as well as ethnography to witness, experience, and understand practices and experiences. Data were analysed, teleologically, to clarify what brilliant practices were supported and promoted.

RESULTS

Brilliant community-based palliative care nursing largely involved maintaining normality in patients' and carers' lives. The nurses demonstrated this by masking the clinical aspects of their role, normalising these aspects, and appreciating alternative 'normals'.

CONCLUSION

Redressing the scholarly preoccupation with gaps, issues, and problems in palliative care, this article demonstrates how what is ordinary is extraordinary. Specifically, given the intrusiveness and abnormalising effects of technical clinical interventions, brilliant community-based palliative care can be realised when nurses enact practices that serve to promote a patient or carer to normality.

PATIENT OR PUBLIC CONTRIBUTION

Patients and carers contributed to this study as participants, while nurses contributed to this study as co-researchers in the conduct of the study, the analysis and interpretation of the data, and the preparation of the article.

Patient safety for people experiencing advanced dementia in hospital: A video reflexive ethnography

BACKGROUND

Patient safety for people experiencing dementia in acute hospitals is a global priority. Despite national strategies as well as safety and quality guidelines, how safety practices are enacted within the complexities of everyday work are poorly understood and articulated.

METHODS

Using video reflexive ethnography, this 18-month study was conducted within an inpatient geriatric evaluation and management unit for people experiencing dementia and/or delirium in Australia. Patients, family members, and staff members participated by: allowing researchers to document fieldwork notes and video-record their practices and/or accounts thereof; and/or interpreting video-recordings with researchers to co-analyse and make sense of the data.

RESULTS

Safe care for people experiencing advanced dementia involved: negotiating risk via leadership, teamwork, and transparency; practice-based learning through situated adaptation; managing personhood versus protocols by doing the 'right' thing; joyful and meaningful work; as well as incorporating patient and family voices to do safety together.

CONCLUSION

Patient safety for people experiencing dementia requires continuous responsiveness and prioritising in the context of multiple risks by a staff collective with a shared purpose. Ongoing research to better understand how the nuances of patient safety unfold in everyday complex clinical realities in diverse contexts and with key stakeholders is required.

'it was that … specialist … that finally listened to us … that's probably a weird answer to what you were expecting': Clinician and carer perspectives on brilliant feeding care

INTRODUCTION

To extend research on positive aspects of health care, this article focusses on health care for children who tube-feed-this is because knowledge about tube-feeding for children is limited and fragmented. This is achieved by consulting with clinicians and carers who supported children who tube-feed to clarify their understandings of and experiences with brilliant feeding care.

METHODS

Nine clinicians and nine carers who supported children who tube-fed were interviewed. The interview transcripts were analysed thematically.

RESULTS

Findings highlighted several features of brilliant feeding care-namely: practices that go above and beyond; attentiveness; empowerment; being 'on the same page'; hopefulness and normalcy.

CONCLUSIONS

These findings show that seemingly trivial or small acts of care can make a significant meaningful difference to carers of children who tube-feed. Such accounts elucidate brilliant care as grounded in feasible, everyday actions, within clinicians' reach. The implications associated with these findings are threefold. First, the findings highlight the need for clinicians to listen, be attuned and committed to the well-being of children who tube-feed and their carers, share decision-making, source resources, and instil hope. Second, the findings suggest that carers should seek out and acknowledge clinicians who listen, involve them in decision-making processes, and continue to source the resources required to optimize child and carer well-being. Third, the findings point to the need for research to clarify the models of care that foster brilliant feeding care, and the conditions required to introduce and sustain these models.

PATIENT OR PUBLIC CONTRIBUTION

All of the carers and clinicians who contributed to this study were invited to participate in a workshop to discuss, critique, and sense-check the findings. Three carers and one clinician accepted this invitation. Collectively, they indicated that the findings resonated with them, and they agreed with the themes, which they indicated were well-substantiated by the data.

'Smiles and laughter and all those really great things': Nurses' perceptions of good experiences of care for inpatient children and young people with intellectual disability

AIM

To understand what constitutes a good experience of care for inpatient children and young people with intellectual disability as perceived by nursing staff.

DESIGN

Interpretive qualitative study.

METHODS

Focus groups with clinical nursing staff from speciality neurological/neurosurgical and adolescent medicine wards across two specialist tertiary children's hospitals in Australia were conducted between March and May 2021. Data analysis followed interpretative analysis methods to develop themes and codes which were mapped to a conceptual model of safe care.

RESULTS

Six focus groups with 29 nurses of varying experience levels were conducted over 3 months. Themes and codes were mapped to the six themes of the conceptual model: use rapport, know the child, negotiate roles, shared learning, build trust and relationships, and past experiences. The analysis revealed two new themes that extended the conceptual model to include; the unique role of a paediatric nurse, and joy and job satisfaction, with a third contextual theme, impacts of COVID-19 pandemic restrictions. With the perspectives of paediatric nurses incorporated into the model we have enhanced our model of safe care specifically for inpatient paediatric nursing care of children and young people with intellectual disability.

CONCLUSION

Including perceptions of paediatric nurses confirmed the position of the child with intellectual disability being at the centre of safe care, where care is delivered as a partnership between nursing staff, child or young person and their parents/family and the hospital systems and processes.

IMPACT

The enhanced model offers a specialized framework for clinical staff and health managers to optimize the delivery of safe care for children and young people with intellectual disability in hospital.

Hearing parents' voices: A priority-setting workshop to inform a suite of psychological resources for parents of children with rare genetic epilepsies

Objective

To understand parents' of children with developmental and epileptic encephalopathies needs and preferences for psychological resources.

Methods

Using a person-based approach, a multidisciplinary panel of clinician and researchers (n = 9) hosted a priority-setting workshop to 1) understand parents' needs and preferences for psychological resources and 2) to develop ‘guiding principles’ to inform a future suite of psychological resources. The multidisciplinary panel analysed the parent priority-setting workshop data, using a combination of thematic and lexical analysis.

Results

Thematic analysis identified six key domains wherein parents (n = 8) prioritised a need for psychological resources to support adaptation to their child's genetic DEE diagnosis. Lexical analysis revealed that connection to diagnosis-specific resources provided a pathway to promote enhanced psychological adaptation, by reducing social isolation and reorienting parents towards feelings of hope. Combination of both analyses generated six thematic informed ‘guiding principles’.

Conclusion

Codesigned psychological resources may help parents to cope with the unique and complex interplay of stressors associated with their child's DEE diagnosis and treatment. Our ‘guiding principles’ will be translated to inform a future suite of tailored psychological resources.

Innovation

This study demonstrates an innovative codesign approach to inform tailored psychological resources for families of children with rare genetic conditions.

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There is a deficit of research exploring the psychological impacts of parenting children with genetic DEEs.

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Tailored and codesigned psychological resources are essential due to the complexity and uniqueness of genetic DEEs.

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We collaborated with parents to codesign the content and scope of a future suite of person-based psychological resources.

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Thematic and lexical analyses combined identified that person-based resources reduced parent isolation and promoted hope.

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Insights generated from this study will be applied to inform psychological resources tailored for rare disease families.

Positive Organisational Arts-Based Youth Scholarship: Redressing Discourse on Danger, Disquiet, and Distress during COVID-19

This methodological article argues for the potential of positive organisational arts-based youth scholarship as a methodology to understand and promote positive experiences among young people. With reference to COVID-19, exemplars sourced from social media platforms and relevant organisations demonstrate the remarkable creative brilliance of young people. During these difficult times, young people used song, dance, storytelling, and art to express themselves, (re)connect with others, champion social change, and promote health and wellbeing. This article demonstrates the power of positive organisational arts-based youth scholarship to understand how young people use art to redress negativity via a positive lens of agency, peace, collectedness, and calm.

Finding Pluto: An Analytics-Based Approach to Safety Data Ecosystems

This review article addresses the role of safety professionals in the diffusion strategies for predictive analytics for safety performance. The article explores the models, definitions, roles, and relationships of safety professionals in knowledge application, access, management, and leadership in safety analytics. The article addresses challenges safety professionals face when integrating safety analytics in organizational settings in four operations areas: application, technology, management, and strategy. A review of existing conventional safety data sources (safety data, internal data, external data, and context data) is briefly summarized as a baseline. For each of these data sources, the article points out how emerging analytic data sources (such as Industry 4.0 and the Internet of Things) broaden and challenge the scope of work and operational roles throughout an organization. In doing so, the article defines four perspectives on the integration of predictive analytics into organizational safety practice: the programmatic perspective, the technological perspective, the sociocultural perspective, and knowledge-organization perspective. The article posits a four-level, organizational knowledge-skills-abilities matrix for analytics integration, indicating key organizational capacities needed for each area. The work shows the benefits of organizational alignment, clear stakeholder categorization, and the ability to predict future safety performance.

Appreciative inquiry as an intervention to improve nursing and midwifery students transitioning into becoming new graduates: An integrative review

OBJECTIVE

To identify, critique and synthesise the evidence about the impact of Appreciative Inquiry on improving nursing and midwifery students as they transition into becoming new graduates.

DESIGN

An integrative review.

DATA SOURCES

The databases were: Pubmed, Ovid Medline, Cumulative Index of Nursing and Allied Health and Scopus.

REVIEW METHODS

A Whittemore and Knafl's (2005) five stage approach was used to appraise the primary literature related to nursing and midwifery students transitioning into becoming new graduates.

RESULTS

A total of 805 articles were retrieved and six studies met the inclusion criteria and included in this review. These studies have shown that Appreciative Inquiry as an intervention can be used to improve nursing and midwifery students' experiences as they transition into becoming new graduates. Three overarching themes were identified: caring, connecting and nurturing, transforming the workplace and work practices and appreciating and enabling nurses and midwives as a profession.

CONCLUSION

Appreciative Inquiry offers a creative, exploratory and compassionate method to improve positive change for nursing and midwifery students as they transition into becoming new graduates. The impact of caring, nurturing nurses and midwives who mentor nursing and midwifery students makes a difference in increasing the likelihood that graduates will remain in the profession and establish fulfilling relationships with both colleagues and people.

Creating equitable healthcare quality and safety for children with intellectual disability in hospital

Children with intellectual disability are susceptible to poor experiences of care and treatment outcomes, and this may compound existing health inequities. Evidence to date indicates three priority areas that must be addressed in order to reduce these inequities in the safety and quality of care for children with intellectual disability. Firstly, we need reliable methods to identify children with intellectual disability so that healthcare organizations understand their needs. Secondly, we need to develop quality metrics that can assess care quality and unwarranted care variation for children with intellectual disability in hospital. Finally, for a comprehensive understanding of the safety and quality of care for these children, and how to improve, it is critical that healthcare organizations partner with parents/carers and enable children with intellectual disability to voice their experiences of care. Children with intellectual disability have higher healthcare utilization than their peers; yet, their voice is rarely sought to optimize the safety and quality of their healthcare experience. Patient experience narratives enhance our understanding of the genesis of adverse events. By addressing these priorities, children with intellectual disability will be identified, and health services will measure and understand the problematic and beneficial variations in care delivery and can then effectively partner with children and their parents/carers to address the inequities in care quality and create safer healthcare.

Navigating and understanding organisational complexity in health services: The value of POSH-VRE

This methodological article introduces positive organisational scholarship in healthcare and video reflexive ethnography (POSH-VRE) as a methodology to cut through the challenges of accessing and engaging organisations for research. We demonstrate how POSH-VRE can open space to navigate and better understand organisational complexity and build capacity. Organisational complexity denotes the interrelated components of a system. POSH-VRE can be helpful within complex organisations, such as health services, because it focuses on positive healthcare practices and experiences. We exemplify this with reference to a study on brilliant community-based palliative care. Using fieldnotes and video-recordings, we reveal the value of positive recognition – or celebration; video-cameras; and courtesy, whereby we adapted to different contexts. POSH-VRE can be of scholarly, methodological, and organisational value. It enables researchers to navigate organisational complexity and co-construct findings with nonacademic experts. Furthermore, it can encourage nonacademic experts to improve practice by learning from their own capacities to navigate organisational complexity.

Healthcare marketing

Purpose

The purpose of this study was to examine the process of the use of management’s positivity and negativity sources and their mediation on pharmaceutical members’ satisfaction that, in turn, enable a health-care organization to meet its business objectives with more agility.

Design/methodology/approach

Data were obtained from a survey of 106 pharmaceutical members regarding their relationships with management.

Findings

The results of LISREL analysis revealed that the use of positivity variables such as reward enhanced each of referent, expert and positive conflict; in addition, referent boosted satisfaction. However, the use of negativity variables such as opportunism enhanced power, but weakened each of referent, expert and legitimate power sources. The use of coercion enhanced power too, but produced dissatisfaction. Further, the prevalence of negative conflict caused dissatisfaction.

Originality/value

This study also reported major contributions when it examined the effect of the mediation of the use of positivity intrinsic power sources on satisfaction. It found that referent power functioned as a full mediator by dropping the amount of the relationship between the use of reward and satisfaction to zero and as a partial mediator by dropping the amount of the relationship between the use of coercion and satisfaction. In addition, the use of referent power mediated the joint effect of both the use of coercion and reward power sources, triggering a positive effect on satisfaction. Several managerial implications were discussed.

Nurse managers: being deviant to make a difference

Within healthcare, studies support that nurse manager leadership behaviours positively influence nursing outcomes. However, how this behaviour promotes positive outcomes is less well understood. Integrating a ‘positive deviance framework’ and a ‘model for reflection’, this paper uniquely uncovers positive nurse manager behaviours that deviate from ‘business as usual’ in managing and leading healthcare staff. Applying an interpretivist lens to qualitative data collected from 24 nurse managers from Australia and Seychelles, the outcomes illustrate examples of positive leadership, exemplary performance, and uncommon behaviours and actions amongst nurse managers resulting in positive nursing experiences and positive organisational outcomes. Nurse managers practising positive leadership and taking on an employee champion role, underscore these behaviours. This study contributes to the research of positive outcomes, processes, and attributes of healthcare organisations and their members.

Fundamental care for people with cognitive impairment in the hospital setting: A study combining positive organisational scholarship and video-reflexive ethnography

AIMS AND OBJECTIVES

To clarify how high-quality fundamentals of care for people with dementia and/or delirium were practised in a specialist geriatric evaluation and management unit.

BACKGROUND

Older people with cognitive impairment represent a significant number of people who are admitted to hospital. They are at increased risk of dying, readmission and long hospital stays, relative to those without cognitive impairment. There is an urgent need to elucidate the conditions that underpin safe and high-quality fundamental care for these patients and their families.

METHODS

Using the innovative methodologies of positive organisational scholarship in healthcare and video-reflexive ethnography, this 18-month study was conducted within an inpatient geriatric evaluation and management unit for people with dementia and/or delirium in South Australia. Patients, family members and staff members (managerial, clinical and nonclinical) participated by allowing researchers to document ethnographic fieldwork notes and film their practices and/or accounts thereof; and/or interpreting digital recordings with researchers in order to make sense of data in a process of co-analysis. This study is reported using Standards for Reporting Qualitative Research reporting guidelines.

RESULTS

High-quality fundamental care for people with dementia and/or delirium in hospital and their families was associated with the special space of the hospital unit; an aptitude for people with dementia; a capacity to translate person-centred fundamentals of care from rhetoric to reality; and an appreciation for teamwork.

CONCLUSION

This study clarified how teams working in hospital can practise high-quality fundamentals of care for older people with dementia and/or delirium. Delivery of high-quality fundamental care in this setting was dependent, not only on nurses, but the entire ward team working cohesively in a "weave of commitment."

RELEVANCE TO CLINICAL PRACTICE

Efforts to improve fundamental care for people with cognitive impairment need to encompass values and philosophy of person-centred care, including the contributions by all staff to care delivery.

Positive organizational scholarship in healthcare: The impact of employee training on performance, turnover, and stress

Based on positive organizational scholarship in healthcare, this study examined the relationships between four dimensions of employee perception of training: workplace stress, organizational outcomes, job performance, and turnover intentions. We hypothesized that employee training perception would have a negative relationship with workplace stress and that stress would mediate the relationship between employee training perception, job performance, and turnover intentions. We obtained data on 317 elderly-care workers in Northern Cyprus and analyzed it using structural equation modeling. Employee training perception was negatively related to workplace stress, and stress was negatively related to job performance and positively related to turnover intention. In line with Job Demand-Resource theory (JD-R), workplace stress partially mediated the relationship between employee training perception and organizational outcomes. The study contributes to the literature by confirming that elderly-care organizations that provide training opportunities for employees can reduce workplace stress, build organizational strengths, and facilitate positive outcomes.

The happiness initiative: Changing organizational culture to make ‘brilliance’ mainstream in aged care

With the ageing of the population, researchers are investigating the experiences of people living and working in residential aged care. Positive organizational scholarship in healthcare (POSH) and its focus on ‘brilliance’ has not been used as a lens for understanding or improving aged care, although the sector prioritizes person-centred, consumer-directed care. In this qualitative case study, through in-depth interviews, a focus group, and observations, we use a POSH lens to explore how forms of leadership, management structures, and human resource practices facilitate positive experiences for both staff and residents. A thematic data analysis identified the importance of authentic leadership in creating a client-centred organizational culture where ‘happiness’ is an explicit core value. Educating and recruiting staff that share this vision, alongside reflective engagement, rituals and symbols, enabled the building of a responsive care culture that facilitated acts of ‘brilliance’ in healthcare.

Intensive care nurses' well-being: A systematic review

BACKGROUND AND PURPOSE

Unique work challenges of intensive care nurses can cause both stress and distress to nurses, evident in prevailing literature regarding burnout, compassion fatigue, and moral distress. Identifying factors contributing to intensive care nurses' well-being would complement this focus on nurse ill-being, supporting the development of workplace well-being initiatives. The review seeks to balance the existing negatively skewed evidence base by investigating intensive care nurses' well-being rather than ill-being.

OBJECTIVES

The objective of this review was to systematically identify, appraise, and synthesise primary research reporting intensive care nurses' well-being.

METHODS

The electronic search strategy included (1) bibliographic databases for published work and (2) forward and backward citation searches. Key search terms included [critical OR intensive] AND [nurs*] AND [well*]. Inclusion criteria were as follows: (1) population: critical or intensive care nurses working with adult or mixed adult and paediatric patients, (2) study type: primary research studies, (3) outcome: intensive care unit nurses' well-being, and (4) publication available in the English language. Studies were excluded if the group of intensive care nurses was not independently reported. Included studies were critically appraised, and results were synthesised and presented descriptively. Semantics of the included studies were explored to identify frequently used terms.

RESULTS

Four primary research studies met the inclusion criteria, focussing on spiritual well-being, team commitment, emotional well-being, and the effects of a mindfulness programme. The studies were heterogeneous in terms of study focus, definitions, and measures, with small sample sizes, and of variable quality and generalisability.

CONCLUSIONS

The well-being of intensive care nurses is currently understudied. Conceptualising intensive care nurses' well-being, understanding correlates of well-being, and testing workplace interventions to improve well-being remain significant opportunities for future research.

What does it take to deliver brilliant home-based palliative care? Using positive organisational scholarship and video reflexive ethnography to explore the complexities of palliative care at home

Background:

Despite the increasing number of people requiring palliative care at home, there is limited evidence on how home-based palliative care is best practised.

Aim:

The aim of this participatory qualitative study is to determine the characteristics that contribute to brilliant home-based palliative care.

Design:

This study was inspired by the brilliance project – an initiative to explore how positive organisational scholarship in healthcare can be used to study brilliant health service management from the viewpoint of patients, families, and clinicians. The methodology of positive organisational scholarship in healthcare was combined with video-reflexive ethnography.

Setting/participants:

Home-based specialist palliative care services across two Australian states participated in the study. Clinicians were able to take part in the study at different levels. Pending their preference, this could involve video-recording of palliative care, facilitating and/or participating in reflexive sessions to analyse and critique the recordings, identifying the characteristics that contribute to brilliant home-based palliative care, and/or sharing the findings with others.

Results:

Brilliance in home-based palliative care is contingent on context and is conceptualised as a variety of actions, people, and processes. Care is more likely to be framed as brilliant when it is epitomised: anticipatory aptitude and action; a weave of commitment; flexible adaptability; and/or team capacity-building.

Conclusion:

This study is important because it verifies the characteristics of brilliant home-based palliative care. Furthermore, these characteristics can be adapted for use within other services.

A decision theory perspective on complexity in performance measurement and management

Purpose

The purpose of this paper is to apply the aspects of decision theory (DT) to performance measurement and management (PMM), thereby enabling the theoretical elaboration of volatility, uncertainty, complexity and ambiguity in the business environment, which are identified as barriers to effective PMM.

Design/methodology/approach

A review of decision theory and PMM literature establishes the Cynefin framework as the basis for extending the performance alignment matrix. Case research with seven companies explores the relationship between two concepts under-examined in the performance alignment matrix – internal dominant logic (DL) as the attribute of organisational culture affecting decision making, and the external environment – in line with the concept of alignment or fit in PMM. A focus area is PMM related to sustainable operations and sustainable supply chain management.

Findings

Alignment between DL, external environment and PMM is found, as are instances of misalignment. The Cynefin framework offers a deeper theoretical explanation about the nature of this alignment. Other findings consider the nature of organisational ownership on DL.

Research limitations/implications

The cases are exploratory not exhaustive, and limited in number. Organisations showing contested logic were excluded.

Practical implications

Some organisations have cultures of predictability and control; others have cultures that recognise their external environment as fundamentally unpredictable, and hence there is a need for responsive, decentralised PMM. Some have sought to change their culture and PMM. Being attentive to how cultural logic affects decision making can help reduce the misalignment in PMM.

Originality/value

A novel contribution is made by applying decision theory to PMM, extending the theoretical depth of the subject.

Empirical exploration of brilliance in health care: perceptions of health professionals

Objective The aim of the present study was to develop a positive organisational scholarship in health care approach to health management, informed by health managers and health professionals' experiences of brilliance in health care delivery. Methods A sample of postgraduate students with professional and/or management experience within a health service was invited to share their experiences of brilliant health services via online discussions and a survey running on the SurveyMonkey platform. A lexical analysis of student contributions was conducted using the individual as the unit of analysis. Results Using lexical analysis, the examination of themes in the concept map, the relationships between themes and the relationships between concepts identified 'care' as the most important concept in recognising brilliance in health care, followed by the concepts of 'staff' and 'patient'. Conclusions The research presents empirical material to support the emergence of an evidence-based health professional perspective of brilliance in health management. The findings support other studies that have drawn on both quantitative and qualitative materials to explore brilliance in health care. Pockets of brilliance have been previously identified as catalysts for changing health care systems. Both quality, seen as driven from the outside, and excellence, driven from within individuals, are necessary to produce brilliance. What is known about the topic? The quest for brilliance in health care is not easy but essential to reinvigorating and energising health professionals to pursue the highest possible standards of health care delivery. What does this paper add? Using an innovative methodology, the present study identified the key drivers that health care professionals believe are vital to moving in the direction of identifying brilliant performance. What are the implications for practitioners? This work presents evidence on the perceptions of leadership and management practices associated with brilliant health management. Lessons learned from exceptionally well-delivered services contain different templates for change than those dealing with failures, errors, misconduct and the resulting negativity.